This invention relates to apparatus and a method for joining, e.g. by stapling or clipping, internal body tissue from outside the body through a small opening in the body. The invention is useful for closing an internal opening in a body cavity from within the body cavity, such as in performing corrective surgery for hernias. More particularly, the invention relates to a procedure and apparatus for the minimally invasive repair of indirect inquinal or femoral hernias utilizing insufflation and laparoscopy.
The problem of herniation is one that may be experienced by men, women and children and generally relates to the abnormal protrusion of an organ or part of an organ or a portion of tissue through an aperture in its containing cavity. The usual, but not the only, hernia treated by this invention is congenital in origin, called an indirect inquinal hernia, and is due to the failure of the inner lining of the abdomen, called the peritoneum, to seal itself at the opening of the inquinal canal during fetal formation. The inquinal canal contains the spermatic cord. In its failure to seal itself, a hole develops with a sock shaped sac hanging downward from that hole. This sac rests inside the inquinal canal. This hole may allow a portion of intestine to slip through it and become pinched or even strangulated. It is necessary to close such an opening immediately or else complications may develop, such as strangulated intestines or in extreme case death.
There are several different traditional (prior art) surgical techniques for closing a hernial defect. All of these techniques have certain basic characteristics in common. Among these common characteristics is the necessity to make a formal 3 to 6 inch incision directly adjacent to the hernial defect which lies generally in the groin region, cutting and pealing back various layers of tissue and dissecting the inquinal canal and the accompanying spermatic cord in order to access the hernial defect at the mouth of the canal. Such procedures require 12 to 15 sutures to close the large and complicated incision. Obviously such procedures leave a rather large and sometimes unattractive scar and are extremely painful to the patient. Most patients are out of work an average of 5 days after such an operation and have restricted movement for over two weeks. More importantly the surgery carries a long list of both general and local complications such as ischemic orchitis and testicular atrophy caused by the dissecting of the spermatic cord off the hernial sac. One of the major problems with current procedures is recurrent herniation. It is estimated that as many as 20% of these procedures recur within 5 to 10 years. One reason for this is that current procedures damage the muscle tissue in the groin region which supports the inquinal area. This muscle tissue then weakens and bulges out due to the pressure of the intestines pushing this area down. Such muscle failure results in a direct inquinal hernia, the repair of which may require a synthetic mesh to reinforce the damaged muscle tissue.
Thus, the performance of such conventional corrective surgery causes severe physical trauma to the operative area and emotional trauma to the patient. Many other complications are possible: those related to any incision, such as bleeding and infection, and those related to conventional hernia procedures, such as damages to bowel and bladder, nerves and large blood vessels. In addition, cutting through so many layers of tissue may severely traumatize the tissue and upset the patient's emotional equilibrium. Other disadvantages of conventional hernia surgery are the long recuperation time and the large unsightly scar.